Hashmi et al.

BMC Health Services Research (2017) 17:500

DOI 10.1186/s12913-017-2442-6

RESEARCH ARTICLE Open Access

A qualitative study exploring perceptions

and attitudes of community pharmacists
about extended pharmacy services in
Lahore, Pakistan
Furqan K. Hashmi1, Mohamed Azmi Hassali1, Adnan Khalid2, Fahad Saleem3, Hisham Aljadhey4,
Zaheer ud Din Babar5 and Mohammad Bashaar6*

Abstract
Background: In recent decades, community pharmacies reported a change of business model, whereby a shift from
traditional services to the provision of extended roles was observed. However, such delivery of extended pharmacy
services (EPS) is reported from the developed world, and there is scarcity of information from the developing nations.
Within this context, the present study was aimed to explore knowledge, perception and attitude of community
pharmacists (CPs) about EPS and their readiness and acceptance for practice change in the city of Lahore, Pakistan.
Methods: A qualitative approach was used to gain an in-depth knowledge of the issues. By using a semi-structured
interview guide, 12 CPs practicing in the city of Lahore, Pakistan were conveniently selected. All interviews were
audio-taped, transcribed verbatim, and were then analyzed for thematic contents by the standard content analysis
framework.
Results: Thematic content analysis yielded five major themes. (1) Familiarity with EPS, (2) current practice of EPS, (3)
training needed to provide EPS, (4) acceptance of EPS and (5) barriers toward EPS. Majority of the CPs were unaware
of EPS and only a handful had the concept of extended services. Although majority of our study respondents were
unaware of pharmaceutical care, they were ready to accept practice change if provided with the required skills and
training. Lack of personal knowledge, poor public awareness, inadequate physician-pharmacist collaboration and
deprived salary structures were reported as barriers towards the provision of EPS at the practice settings.
Conclusion: Although the study reported poor awareness towards EPS, the findings indicated a number of key
themes that can be used in establishing the concept of EPS in Pakistan. Over all, CPs reported a positive attitude
toward practice change provided to the support and facilitation of health and community based agencies in Pakistan.
Keywords: Qualitative study, Perception, Attitudes, Community pharmacists, Extended pharmacy services, Pakistan

Background patient-focused model [1, 2]. Therefore, the practice of

During the past few decades, pharmacy services
witnessed a transition of roles of professional practice.
The count-and-pour system replaced the customary
compounding role, and more recently was transformed
to the delivery of pharmaceutical care. Since the adop-
tion of pharmaceutical care in the early 90s, the role of
pharmacist changed from being product oriented to
* Correspondence: mohammad.bashaar@yahoo.com
6
SMART Afghan International Trainings & Consultancy, Kabul, Afghanistan
Full list of author information is available at the end of the article
pharmaceutical care is applicable in all settings i.e. com-
munity, hospital, clinics and long-term care [3]. Within
this context, pharmaceutical care has evolved to
embrace different services at the community level. These
services range from brief counselling following medication
purchase to lengthy extensive counselling services and
other value added services known as extended pharmacy
services (EPS) [4].
Extended pharmacy services are referred to those ser-
vices which are not associated with traditional services

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Hashmi et al. BMC Health Services Research (2017) 17:500
offered by the pharmacists such as dispensing and provid-
ing individual consultations on prescription and over-the-
counter (OTC) medications, but include new series of
services for example, medications therapy management
(MTM), home medication review (HMR) which involve
comprehensive medication reviews to look for
medication-related problems and all aspects of chronic
disease management (CDM) which may include screening,
patient education and knowledge, disease monitoring and
communication with the primary healthcare team [4, 5].
Extended Pharmacy Services require additional or special
skills, knowledge and/or facilities, and are provided to
people with special needs [6]. In addition to the provision
of safe and effective prescribed pharmacy- and self-selected
medicines, a growing diversity of additional services are
being developed and remunerated in developed countries
[6] and the new role of community pharmacists as a key
personal of the multidisciplinary provision of healthcare is
openly accepted [7]. In Australia for an instance, commu-
nity pharmacist is considered as a health practitioner and
educator for the public [8]. In the United Kingdom (UK),
government has introduced New Medicine Service (NMS)
for community pharmacists to promote self-care and to
improve the management of long term conditions [9]. In
the US, community pharmacist is considered as a readily
accessible primary healthcare provider [10], while the com-
munity pharmacists in Canada play proactive role as
providers of primary healthcare services [11, 12]. On the
contrary, community pharmacy practice is totally different
in the developing countries and the practices are typically
confined to traditional practices of dispensing and a
business oriented approach is followed [7, 13]. Shifting our
concern to the concept of EPS in Pakistan, the notion is still
naïve to the community pharmacists and public. Pakistan is
the 6th most populous country in the world [14]. The
healthcare system of the country is a three-tiered structure,
with primary, secondary and tertiary healthcare units [15].
The sales of medicines, by way of retail and wholesale, are
regulated by the Drug Act 1976 [16]. The practice of
pharmacy, education, establishment of council (Pakistan
Pharmacy Council and Provincial Councils) and registra-
tion pharmacists are under the provisions of Pharmacy Act
1967 [17]. The registration of graduate pharmacists is a
straightforward process. The graduates from recognized in-
stitutions and universities providing pharmacy education,
apply for the registration to the respective Provincial
Pharmacy Councils, as pharmacist, ‘qualified person’ to be
registered under, ‘Register A’, termed as ‘Category A’ (certifi-
cate of registration), under Section 23 of the Pharmacy Act
1967 [17]. The provincial council in the province of Punjab
is known as the Punjab Pharmacy Council (PPC), situated
in Lahore. All the study respondents in our study setting
are legitimate registered graduate pharmacists with PPC,
Lahore. According to the record of PPC 15,702 pharmacists
Page 2 of 9
have been registered as of December 2016 [18]. The quali-
fied pharmacists (registered) apply for license to practice as
community pharmacist in the Office of the Executive
District Officer-Health (EDO-Health) Department of
Health, City District Government, Lahore.
In contrast to the situation in developed countries,
community pharmacists are underutilized as they are
not considered as healthcare professionals and hence
their role is neither identified nor recognized in the
healthcare system [19]. This lack of recognition is attrib-
uted to limited interaction of pharmacists with people as
well as lack of awareness among public [20, 21]. As far
as community pharmacy services are concerned, like
other developing countries, pharmacists are involved in
the dispensing of medicines and follow a business-
oriented approach. Prescription handling and patient’
management is least seen at community pharmacies
in Pakistan [22, 23]. Although a small number of
pharmacies offer patient counselling services, overall
provision of community pharmacy services is poor in
Pakistan [21]. In majority of the cases, pharmacies in
Pakistan are owned by non-pharmacist (businessmen) and
they are more focused toward flourishing their business
rather than focusing on patient care and other patient-
oriented services. There is a lack of sufficient pharmacists
to work as well as the physical presence of pharmacists at
the community pharmacies are the challenges faced
currently in Pakistan. Generally, majority of community
pharmacists are unaware of the concept of extended
pharmacy services [24]. There is lack of awareness in
public about the role of community pharmacist as well as
the collaboration among the healthcare professionals,
as pharmacist-physician interaction is not there in
appreciable extent [25].
Therefore, this qualitative study was conducted with
an objective to explore the perception and attitude of
community pharmacists about their extended role in the
community pharmacies in Lahore, Pakistan.
Methods
Study design
A qualitative methodology was adopted to explore the
perception and attitude of community pharmacists about
the EPS. We adopted a qualitative design for various rea-
sons. The design is flexible and consents to an in-depth
exploration of respondents’ attitudes, experiences and
intentions [26, 27]. In addition, qualitative methods gen-
erate a wide range of ideas and opinions that individuals
carry out about the issues, as well as divulge viewpoint
differences among groups [27]. Furthermore, for under
discovered research areas, qualitative methods attempt
to fill in gaps that are left unexposed by survey based re-
search [28]. Therefore, inline to the objectives of this
study, qualitative interviews were a superlative choice
Hashmi et al. BMC Health Services Research (2017) 17:500
for inductive approaches aimed at generating concepts
and hypothesis that have far more potential for research
than any other models [29].
Instrument development
Based on an in-depth literature review [19, 30–49] and
current prevailing practices of community pharmacy in
Pakistan, a semi structured interview guide was devel-
oped [50]. The guide focused on knowledge of EPS,
perception towards current community pharmacy prac-
tice in Pakistan, knowledge and confidence in practice
change, customers’ feedback, and future interventions
towards practice change. The guide was subjected to
validation and reliability assessment prior to data collec-
tion. Qualitative experts at Universiti Sains Malaysia
validated the interview guide by using a combination of
argumentative and cumulative techniques. Argumenta-
tive validation uses data as a squabble source to over-
come one contradictory viewpoint [51]. Cumulative
validation is the method of cross referencing whereby
the researchers use accessible literature to match the
findings. Based upon the nature of data and availability
of resources, the present study followed cumulative
process of validation. Reliability of research was assured
by preserving records of face-to-face interviews of the
respondents of the study. The guide was piloted on two
community pharmacists and was modified accordingly.
As mutual consent of the experts and CPs was received,
the interview guide was made available for real-time
study (refer to Additional file 1).
Study setting
The study was conducted in Lahore. It is the capital of
the province of Punjab, second largest and most
populous city of Pakistan having a little over 7.2 million
inhabitants with 81.17% urban settlement [52]. Beside
the reasons of being the capital city and second most
populous, Lahore is considered as the major centre for
health facilities, education, business and culture. The
community pharmacy sector is considered to be well
established in Lahore, having both independent- and
chain-type of pharmacies.
Respondents and inclusion criteria
There are 3618 registered licence pharmacies in Lahore
[53]. Community pharmacists, registered at the Punjab
Pharmacy Council (PPC) and practicing either at
independent and chain pharmacies with minimum 8 h
per day presence at pharmacy were targeted for data
collection. Moreover, only those pharmacies were tar-
geted which employed full-time licensed pharmacists.
Pharmacy technicians and non-registered pharmacists
were excluded from the study.
Page 3 of 9
Sampling, data collection and processing
Participants were recruited using purposive methods
until saturation of themes was achieved. Purposive sam-
pling was done based on the preconceived ideas about
the required characteristics of the sample. Thus, target-
ing and identifying those individuals who had experience
in community pharmacies and were influential about
service development. Interviews with consented partici-
pants were conducted after individual appointments.
The interviews were conducted in English (pharmacists,
generally are good in English speaking as the medium of
instruction in institutions and universities is Pakistan is
exclusively in English language). Each interview lasted
for 30 to 40 min. Probing questions were asked and par-
ticipants were given freedom to express additional views
and comments. All interviews were audio-recorded and
the principle researcher took additional field notes. The
saturation was achieved at the 10th interview; however,
two interviews were carried out further to confirm the
saturation. The interviews were verified for accuracy and
consistency by listening to the recordings. The first
author analysed the transcripts line by line, which were
read repeatedly and thematically analysed for their
contents. Co-authors of the study verified the emerging
themes and contents.
Results
Twelve CPs were interviewed. All participants were
males (as females do not prefer to work in community
pharmacies due to social reservations). Majority (n = 8)
of the respondents were from the age group of 20–
30 years and six were the managers of the community
pharmacy. Eight CPs had a working experience of 1–
5 years at community pharmacies as shown in Table 1.
During the analysis, five major themes were identified;
(1) Familiarity with EPS, (2) current practice of EPS, (3)
training needed to provide EPS, (4) acceptance of EPS
and (5) barriers toward EPS.
Theme 1: Familiarity with the extended pharmacy
services (EPS)
During the interviews, the respondents were asked for
their knowledge and information about EPS. Majority of
the respondents had no idea about the EPS while a few
CPs reported a little familiarity with EPS. Only two CPs
had updated knowledge about EPS. This may be attrib-
uted to the fact that the young pharmacists with experi-
ence of 1 to 2 years keep themselves updated with the
latest developments taking place in pharmacy practice
around the world.
“No I don’t have any idea about extended pharmacy
service, its new to me however we are offer services as
blood pressure monitoring, blood sugar monitoring,
Hashmi et al. BMC Health Services Research (2017) 17:500 Page 4 of 9

Table 1 Demographic characteristics of the study respondents specific information as patient history, allergies or
(n = 12) medical record. Provision of EPS at the community
Characteristics Frequency pharmacies was least reported and principal focus of
Age (years) community pharmacy was increased sales through
20–30 8 medicines and other products.
31–40 1
“The system of practice is typically dispensing, patients
> 40 3
present their prescription at the counter the technician
Gender or pharmacist simply handover the medicine and
Male 12 charge” (CP7)
Educational status
B. Pharmacy 5 “Community pharmacy practice is typically selling of
medicines in Pakistan it is not well defined and far
Pharm. D 2
from the concept of EPS” (CP8)
M. Phil 5
Experience (years) Theme 3: Training needed to provide EPS
1–5 years 8 Training of pharmacists was considered an important
6–10 years 1 component for better services. Majority of the CPS had
> 10 years 3 no formal training before joining the community
pharmacy practice. The employer provided training for a
Status in Pharmacy
certain period while working in the pharmacy. The CPs
Employee 5
responded in a positive way to this aspect of pharmacist’s
Manager 6 capacity building. Respondents also added that for
Proprietor 1 provision of EPS, they need training so that they can
Prescriptions filled/day collaborate with other stakeholders at the community level.
1–20 2
“The training of pharmacists regarding extended
> 20 10
pharmacy services is very important and it must be
Location of pharmacies
under the supervision of the government and
Urban 12 organized training programs should be there” (CP2)

counselling, but more confined to BP and sugar
monitoring services only” (CP4)
“I have slight idea about extended pharmacy services.
We also give services like BP monitoring, blood sugar
test, body weight and advice about the medicines
patients are using and we also address issues
regarding prescriptions” (CP3)
The pharmacist having good update knowledge about
the extended pharmacy services expressed views as:
“The role of pharmacists beyond the typical dispensing
services is known as the extended pharmacy services
and health care services, I conduct MTM service on
my own” (CP1)
Theme 2: Current system of practice and EPS in
community pharmacies in Lahore
The overall response of participants regarding the
current system of practices and sales in community
pharmacies was uniform. Community pharmacies typic-
ally work as a shop with no concept of keeping patient
“Continuous education programs for community
pharmacists are necessary and should be conducted on
regular basis by the pharmacy council” (CP6)
Theme 4: Acceptance of EPS
Majority of the CPs were positive towards EPS and ready
to accept the change. However, CPs had the reservation
that the government must take initiative so that they can
provide EPS without any apprehension and uncertainty.
“Definitely making good standards of practice, laws
and regulation with emphasis on EPS we will be able
to be at par with any place in the world”(CP11)
“Yes it’s necessary in Pakistan where a significant
number people living cannot afford to visit physicians,
therefore for easy access to quality medicines pharmacist
can play extended role in public health”(CP9)
Theme 5: Barriers towards adoption of EPS
Community pharmacists were asked about the barriers
toward adoption of EPS in Pakistan. Lack of training
programs for CP, amendments in existing laws and
Hashmi et al. BMC Health Services Research (2017) 17:500
prevailing government policies were considered as
barriers to practice change. Other limitations indentified
by the participants were poor salary structures, insecur-
ities in job, shortage of pharmacist and renting out of
pharmacists’ practicing licenses.
“Well the barriers are……….the law doesn’t clearly
state what pharmacists are allowed to do? Educating
the people or creating awareness about the pharmacist
and its professional role. Developing services in a way
what people want to be treated like” (CP1)
“The government should provide the job description for
community pharmacists as there is no such binding…
EPS need to be indentify to start with by the government
……on the part of pharmacies we can help develop the
human resource and can help in building the capacity
of community pharmacists” (CP4)
In addition to that patients’ acceptability of advice
from pharmacist, the role of physicians was also pointed
out as a barrier.
“There are barriers as patient has not much confidence on
pharmacist…..after counselling they still prefer to consult
their physician …Or in other words our healthcare system
is dominated by doctors……only small percentage of
patients accepts the pharmacist’s intervention. Another
major barrier is the timing or the patients are always in
hurry, it’s just a shop of medicines for them” (CP6)
Discussion
As far as community pharmacy services and practices
are concerned, EPS is a new concept in Pakistan. Within
this context, although several studies are reported in lit-
erature on the delivery of EPS in developing countries
[54–56], however there is paucity of information from
Pakistan and knowledge and perception of CPs towards
EPS is uncertain. The present study reported poor famil-
iarity of CPs towards EPS in Pakistan and suggested
multiple factors that must be addressed to bring practice
change at community pharmacies in Pakistan.
A handful of our respondents had a clear idea and
concept of EPS; however, majority of the respondents
were unaware of EPS. This warrants insufficient expos-
ure of pharmacists during their undergraduate studies as
pharmacy curriculum in Pakistan follows traditional
classroom teaching methodology. In fact, the pharma-
cists are required to have knowledge and skills extending
beyond the typical roles in the community pharmacy
[57]. In addition to the lack of exposure, practicing phar-
macists in Pakistan often fail to update their skills and
knowledge as per trends and innovations being used and
introduced around the globe. Therefore, in order to
Page 5 of 9
maximize the utilization of CPs at the community level,
a set of unique structured strategies and health system
reforms are required to be introduced to enhance the
knowledge and working capacity of CPs in Pakistan [58].
These strategies must aim to introduce trainings for CPs
that can help in increasing the confidence in providing
EPS to the population. These trainings on patient-
centred activities should be on regular basis in the form
of continuous pharmacy education (CPE) and continu-
ous professional development (CPD) programs. These
programs must be accredited from the Pharmacy Council.
The CPE may include the aspects of EPS such as; MTM,
HMR, CDM and information about public health issues.
Additionally, the pharmacy curriculum should be designed
to have aspects of patient care to be practiced by CPs and
render services to public. A confident and well-trained
pharmacist will be able to offer public health services
more actively and will likely to have a positive impact on
health-related issues [59]. The government should
organize educational programs for community pharma-
cists to equip them for their extended roles in community
practice [60].
The current scenario of community pharmacy practice
in Lahore can be explained by the Transtheoretical
Model of change (TTM) [61]. Transtheoretical model
explains the behaviour change and the readiness of an
individual to act on new behaviour, provides new strat-
egies or processes of change and guides individual
through different stages if change and sustenance of the
change. Since, the present study intended to explore the
current trends of practices, readiness of CPs towards
practice change and provision of EPS, therefore, we
believe this behaviour may best be explained by the
TTM. Based on the model, CPs working in Lahore had a
mixed behaviour towards need for practice change. The
study has shown that those having more than 10 years
of experience (aged 31 to >40) were in pre-
contemplation stage or had no clear idea about the EPS
and pharmaceutical care. On the contrary, young
pharmacists with experience ranging from 1 to 5 years
(aged 20 to 30) seem to be at the contemplation stage.
The results notwithstanding, it is important that the
pharmacists should be educated properly about their ex-
tended roles while working in community pharmacy
during their undergraduate studies. It should also be ad-
dressed by the government to provide on job certified
trainings (accredited CPE programs) to pharmacists and
formalize the provision of EPS. This will create
awareness among CPs and can shape as a mediating
factor in the development of the preparation phase.
Once the CPs join practice, continuous monitoring
through the respective stakeholders such as; health
department, pharmacy council and professional phar-
macy association, addressing the healthcare needs of
Hashmi et al. BMC Health Services Research (2017) 17:500
public will result in the provision of EPS (action) and
maintenance.
Our study findings are supported by the work done by
Menghuan Song and co-workers, in China, stating that
poor familiarity of community pharmacists towards EPS
is linked to limited care knowledge and lack of human-
and financial resources [62]. The current study revealed
that only some aspects of pharmaceutical care are
conducted by CPs in community pharmacies and the
CPs are conducting services on their own, for instance
following up patients with chronic diseases as diabetes
and hypertension. Similar sort of activities have been
reported in community pharmacies of Khartoum, Sudan
[63]. The advice to patient particularly about the lifestyle
modifications is considered to be an important part of
CP’s job, however, only few CPs were ready and able to
provide such services and they were of the opinion that
some extra remuneration would be helpful in addition
to their salary package being offered by the pharmacy
they work for [64].
Despite the easy access of public to pharmacies and
CPs, there is still lack of recognition of pharmacists as
healthcare provider by other stakeholders (physicians,
nurses, paramedics) of healthcare system in Pakistan.
This finding of study is in line with those studies carried
out in majority of the developing countries [22, 65].
Sales of drugs as well as prescription only medicine
(PoM), even antibiotics are being dispensed or sold with-
out prescription is a common practice in majority of the
pharmacies in the city [66]. The overall process of
prescription handling, history taking and medication
counselling is either limited, only few pharmacies offer,
or seldom present in majority of pharmacies [22, 65].
Provision of proper records of patients in integrated
manner should be maintained and made mandatory by
the government at each community pharmacy to serve
the society in a better way [25].
Pharmacists working in community pharmacies in
Pakistan are not trained for their role in rendering EPS.
The community pharmacists usually work in isolation
from the rest of the healthcare team, predominantly
working as drug retailers and drug dispensers. Pharmacists
are believed to be well suited to assume an extended role in
the healthcare system, despite their current role as retailers
[67]. Taking on as patient-focused responsibilities is com-
mensurate with the profession’s training and expertise. The
CPs working in the current study setting are pharmacy
graduates of two streams; an old scheme of study known as
bachelor of pharmacy (B. Pharmacy) with 4-years duration,
while the other introduced in 2005 as undergraduate study
5-years duration known as the doctor of pharmacy (Pharm.
D), it was designed to have clinical contents with more
patient oriented approach [68]. Despite of this scheme of
study the pharmacists are still lacking in the trainings
Page 6 of 9
required for the practical field. The Pharmacy Council of
Pakistan and the provincial councils should take initiative
for the training of community pharmacists for their
extended roles. The government should introduce such
schemes that people would know pharmacists’ role as
primary healthcare workers provided pharmacists are
appropriately trained. Preparing and teaching current phar-
macy students to be resourceful for their extended roles in
community pharmacies will be beneficial for profession and
the healthcare system as a whole [5].
The respondents of study expressed their views about
the readiness and acceptance of change. It is important
that CPs in the study setting be prepared for the accept-
ance and changes in the practice to provide quality
patient-centred services. The transformation or reform
can be difficult and challenging even in the developed
countries [69]. Recently, developed countries as
Australia, Canada, England and the USA have under-
taken a range of reforms with the objective of equipping
CPs with extended roles and responsibilities when caring
for people with multiple chronic conditions however, the
pharmacists found it to be challenging to accept this
change [4, 38, 69]. The government needs to play
proactive role to make laws to establish EPS in commu-
nity pharmacies. There should be a liaison between the
pharmacists and other healthcare workers.
There were several barriers to effective pharmacy prac-
tice model identified that are perceived by the CPs work-
ing at community pharmacies. Our study reports lack of
sufficient human resource as community pharmacists to
cater for the needs of huge population as one of the
major barriers [26]. The common practice in Lahore is
that pharmacists usually rent their licenses to the owners
of pharmacies without being physically present on the
pharmacy premises. This can be considered as another
important barrier. Recently, the Drug Court, Lahore has
ordered the drug inspectors (regulators) all over Punjab
to ensure the physical presence of pharmacists at the
pharmacies otherwise they could cancel the license and
impose penalties as well. Public awareness about phar-
macists has been perceived as another barrier. Despite of
80% urban population of our study setting, people still
have very little idea about the services that a pharmacist
could offer them for their health-related issues. There is
a cycle of dysfunction in which pharmacists hindered by
time do not provide patient care beyond dispensing of a
product, as a result patients rely on their physician for
advice about medications and they do not acknowledge
the pharmacist as an advisor for medication [70]. This
sort of behaviour is believed to be responsible for creat-
ing no motivation for both patients and CPs. This can
be overcome by creating awareness about the pharmacist’s
healthcare role in the public. Similar findings were
presented by Xiang Lang and co-workers in Pakistani
Hashmi et al. BMC Health Services Research (2017) 17:500
healthcare system stating that there is a gap between the
public and the pharmacist, which can only be plugged in
by creating awareness among public regarding pharma-
cists’ role in healthcare system [71]. Even in developed
countries the patients or public have lack of trust on the
care services provided by the community pharmacists
[72]. The public’s trust can be developed by increasing the
quantity of patient-pharmacist interactions and quality of
service [43] and gaining GP support of EPS [73, 74].
Another important barrier identified was the salary struc-
ture of CPs working in community pharmacies. Currently
the remuneration and salaries are inappropriate that lead
to the discouraging working environment for pharmacists.
In fact, this is one of the reasons of less number of
pharmacists making community pharmacy a career. Ad-
equate remunerations are believed to be necessary for
provision of extended pharmacy services warranting better
public health [75].
The role of pharmacists in patient care emphasized, as
one of the respondents, mentioned that the affordability
medicines and access to physician was compromised for
a significant number of people in Pakistan. Address-
ing provider-related barriers could help in better ac-
cess to healthcare services [76]. In this scenario, CPs,
could be a good choice to help people for the treat-
ment and advice for their minor illnesses through
community pharmacies.
Limitations of the study
This study was conducted in Lahore which is the sec-
ond largest city in Pakistan. The results of our study
may not be representing the trends of EPS in the
whole country.
Conclusion
This study showed a lack of awareness of majority of CPs
about the EPS and pharmaceutical care in community
pharmacies in Lahore, Pakistan. However, the CPs showed
a good attitude toward practice change provided the
government plays its role to remove the barriers for the
implementation of EPS in community pharmacies and
ultimate benefit of the public for primary care issues.
Additional file
Additional file 1: The file entitled ‘interview guide’ is the semi structured
interview guide. The file contains the questions in sequence that were
asked during the interview sessions. (DOCX 18 kb)
Abbreviations
CDM: Chronic disease management; CPD: Continuous professional
development; EPS: Extended pharmacy services; HMR: Home medication
review; MTM: Medications therapy management; NMS: New medicine
service; OTC: Over-the-counter; PoM: Prescription only medicine; PPC: Punjab
pharmacy council
Page 7 of 9
Acknowledgements
We would like to thank all CPs for their agreement and participation.
Funding
No funding to disclose.
Availability of data and materials
The dataset supporting the conclusions of this article will be available on
request (Discipline of Social and Administrative Pharmacy, School of
Pharmaceutical Sciences, Universiti Sains Malaysia. E-mail: dean_pha@usm.my).
Authors’ contributions
FKH and AK conducted the interviews and drafted the initial manuscript.
MAH, FS and ZUB supervised the study. HA and MB helped in thematic
content analysis, interpretation and manuscript revision. All authors have
read and approved the final manuscript.
Ethics approval and consent to participate
Humans Ethics Committee, University College of Pharmacy, University of the
Punjab, Lahore, Pakistan (D/HEC/100/UCP1923) approved the study. Written
informed consent was also obtained from the participants. The respondents
were assured of the confidentiality of their responses and their right to
withdraw from the study.
Consent for publication
Not applicable.
Competing interests
The authors declare that there are no competing interests.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
Author details
1
School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang,
Malaysia. 2Combined Military Hospital, Quetta, Pakistan. 3Faculty of Pharmacy
& Health Sciences, University of Baluchistan, Quetta, Pakistan. 4College of
Pharmacy, King Saud University, Riyadh, Saudi Arabia. 5Department of
Pharmacy, School of Applied Sciences, University of Huddersfield,
Huddersfield, West Yorkshire, England. 6SMART Afghan International Trainings
& Consultancy, Kabul, Afghanistan.
Received: 11 August 2016 Accepted: 11 July 2017
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